As a way of monitoring managed care plan performance and improving the quality of care provided to New York State residents, the New York State Department of Health (NYSDOH) collects data for four types of managed care insurance (commercial HMO, commercial Preferred Provider Organization, Medicaid managed care, and Child Health Plus) on an annual basis. Not all measures are collected each year. Some services require more resource intensive methods of collection, and these measures are collected every other year to reduce the burden associated with reviewing patient records. Refer to the Health Measures Descriptions document to learn about the specific measures included in this dataset. Measure specification changes and health plan mergers and closures preclude the ability to trend this data over time. Please use caution when attempting to compare measures and/or health plans over time. For more information, check out http://www.health.ny.gov/health_care/managed_care/reports/quality_performance_improvement.htm, or go to the "About" tab.

This dataset aggregates and displays the number of New York State Medicaid enrollees by eligibility year and month within each NYS Economic Region; health insurance plan information; and enrollee demographics. For more information, check out http://www.health.ny.gov/health_care/medicaid/, or go to the "About" tab.

This dataset includes Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the Delivery System Reform Incentive Payment (DSRIP) Program. The DSRIP program will promote community-level collaborations and focus on system reform, specifically a goal to achieve a 25 percent reduction in avoidable hospital use over five years. For more information on DSRIP, please see http://www.health.ny.gov/health_care/medicaid/redesign/?utm_source=doh&utm_medium=hp-button&utm_campaign=mrt. As a part of the DSRIP program, Performing Provider System will employ multiple projects both to transform health care delivery as well as to address the broad needs of the population that the performing provider system serves. These projects described in Attachment J are grouped into different strategies, such as behavioral health, within each Domain (System Transformation Projects (Domain 2), Clinical Improvement Projects (Domain 3), and Population-wide Projects (Domain 4). For each strategy, there is a set of metrics that the performing provider system will be responsible for if they do any one of the projects within that strategy. This dataset includes only Domain 3 Clinical Metrics. For more information about the measures included in the dataset, check out: http://www.health.ny.gov/health_care/medicaid/redesign/docs/strategies_and_metrics_menu.pdf or go to the "About" tab.

The dataset contains Potentially Preventable Readmission observed, expected, and risk adjusted rates by hospital for Medicaid enrollees beginning in 2011.
The Potentially Preventable Readmission (PPR) software created by 3M Health Information Systems, identifies hospital admissions clinically related to an initial admission within a specified time period. For this dataset, readmissions were evaluated within a 30-day time period from the discharge date of the initial hospital admission. A PPR may have resulted from a deficiency in the process of care and treatment at the initial hospitalization or lack of post discharge follow up. PPRs are not defined by unrelated events that occur post-discharge, such as admissions for trauma.
For each hospital, the total number of at risk admissions, the total number of observed PPR chains, the observed PPR rate, the expected PPR rate, and risk adjusted PPR rate are presented by year. For more information, check out http://www.health.ny.gov/health_care/medicaid/, or go to the "About" tab.

The datasets contain number of Medicaid PQI hospitalizations (numerator), county Medicaid population (denominator), observed rate, expected number of hospitalizations and rate, and risk-adjusted rate for Agency for Healthcare Research and Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid enrollees beginning in 2011.
The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately. All PQIs apply only to adult populations (over the age of 18 years).
The rates were calculated using Medicaid inpatient data for the numerator and Medicaid enrollee characteristics for the denominator.
The observed, expected, and risk-adjusted rates for each AHRQ PQI is presented by either resident county (including a statewide total) or resident zip code (including a statewide total). For more information, go to http://www.health.ny.gov/health_care/medicaid/, or go to the "About" tab.

The datasets contain number of Medicaid PQI hospitalizations (numerator), county Medicaid population (denominator), observed rate, expected number of hospitalizations and rate, and risk-adjusted rate for Agency for Healthcare Research and Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid enrollees beginning in 2011.
The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately. All PQIs apply only to adult populations (over the age of 18 years).
The rates were calculated using Medicaid inpatient data for the numerator and Medicaid enrollee characteristics for the denominator.
The observed, expected, and risk-adjusted rates for each AHRQ PQI is presented by either resident county (including a statewide total) or resident zip code (including a statewide total). For more information, go to http://www.health.ny.gov/health_care/medicaid/, or go to the "About" tab.

The dataset consists of details of the payments made by the NYS Medicaid Electronic Health Record (EHR) Incentive program to healthcare professionals and hospitals. Authorized by the American Recovery and Reinvestment Act (ARRA) of 2009, this program provides multi-year financial incentives to Eligible Professionals (EP) and Eligible Hospitals (EH) who adopt, implement, or upgrade, and subsequently demonstrate meaningful use, of certified Electronic Health Records (EHR) technology. For more information check out: https://www.emedny.org/meipass/ or go to the "About" tab.

This data set contains statewide Medicaid beneficiary counts by valid NYS five digit zip code. Also in this file are counts of beneficiaries who are dual eligible for Medicaid and Medicare, total inpatient admissions, total emergency room visits, and Prevention Quality Indicator-Adult (PQI) admissions.
For more information, go to http://www.health.ny.gov/health_care/medicaid/, or go to the "About" tab.

This dataset contain information on selected chronic health conditions in the Medicaid population at the county level. The chronic health conditions were identified through 3M Clinical Risk Group software and Medicaid enrollment/eligibility, encounter, claim and pharmacy data over a 12 month period. The chronic health categories represented in the data file are: Diabetes Mellitus, Diseases and Disorders of the Cardiovascular System, Diseases and Disorders of the Respiratory System, HIV Infection, Mental Diseases and Disorders, Newborn and Neonates and Substance Abuse. Beneficiaries may be represented in more than one category. All conditions that have 20 or less unique beneficiaries are suppressed from this data file.
For more information, go to http://www.health.ny.gov/health_care/medicaid/, or go to the "About" tab.

This data set contains information on selected chronic health conditions in the Medicaid population at the zip code level. The chronic health conditions were identified through 3M Clinical Risk Group software and Medicaid enrollment/eligibility, encounter, claim and pharmacy data over a 12 month period. The chronic health categories represented in the data file are: Diabetes Mellitus, Diseases and Disorders of the Cardiovascular System, Diseases and Disorders of the Respiratory System, HIV Infection, Mental Diseases and Disorders, Newborn and Neonates and Substance Abuse. All conditions that have 20 or less unique beneficiaries are suppressed from this data file.
For more information, go to http://www.health.ny.gov/health_care/medicaid/, or go to the "About" tab.

The datasets contain number of Medicaid PDI hospitalizations (numerator), county or zip Medicaid population (denominator), observed rate, expected number of hospitalizations and rate, and risk-adjusted rate for Agency for Healthcare Research and Quality Pediatric Quality Indicators – Pediatric (AHRQ PDI) for Medicaid enrollees beginning in 2011.
The Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Indicators (PDIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately. Both the Urinary Tract Infection and Gastroenteritis PDIs include admissions for patients aged 3 months through 17 years. The asthma PDI includes admissions for patients aged 2 through 17 years. Eligible admissions for the Diabetes Short-term Complications PDI includes admissions for patients aged 6 through 17 years.
The rates were calculated using Medicaid inpatient hospital data for the numerator and Medicaid enrollment in the county or zip code for the denominator.
The observed counts and rates, expected counts and rates, risk-adjusted rates and the difference between the number of observed and expected PDI hospitalizations for each AHRQ PDI are presented by either resident county (including a statewide total) or resident zip code (including a statewide total). For more information, check out: http://www.health.ny.gov/health_care/medicaid/ or go to the "About" tab.

The datasets contain number of Medicaid PDI hospitalizations (numerator), county or zip Medicaid population (denominator), observed rate, expected number of hospitalizations and rate, and risk-adjusted rate for Agency for Healthcare Research and Quality Pediatric Quality Indicators – Pediatric (AHRQ PDI) for Medicaid enrollees beginning in 2011.
The Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Indicators (PDIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately. Both the Urinary Tract Infection and Gastroenteritis PDIs include admissions for patients aged 3 months through 17 years. The asthma PDI includes admissions for patients aged 2 through 17 years. Eligible admissions for the Diabetes Short-term Complications PDI includes admissions for patients aged 6 through 17 years.
The rates were calculated using Medicaid inpatient hospital data for the numerator and Medicaid enrollment in the county or zip code for the denominator.
The observed counts and rates, expected counts and rates, risk-adjusted rates and the difference between the number of observed and expected PDI hospitalizations for each AHRQ PDI are presented by either resident county (including a statewide total) or resident zip code (including a statewide total). For more information, check out: http://www.health.ny.gov/health_care/medicaid/ or go to the “About” tab.

The datasets contain Potentially Preventable Visit (PPV) observed, expected, and risk-adjusted rates for Medicaid beneficiaries by patient county and patient zip code beginning in 2011.
The Potentially Preventable Visits (PPV) obtained from software created by 3M Health Information Systems, are emergency visits that may result from a lack of adequate access to care or ambulatory care coordination. These ambulatory sensitive conditions could be reduced or eliminated with adequate patient monitoring and follow up.
The rates were calculated using Medicaid inpatient and outpatient data for the numerator and Medicaid enrollment in the county or zip code for the denominator.
The observed, expected and risk adjusted rates for PPV are presented by either resident county (including a statewide total) or resident zip code (including a statewide total). For more information, check out: http://www.health.ny.gov/health_care/medicaid/ or go to the "About" tab.

The dataset contains the number of Medicaid Low Birth Weight newborns (numerator), the number of county Medicaid newborns (denominator), and observed rate for Agency for Healthcare Research and Quality Prevention Quality Indicator 9 (PQI 9) – Newborn Low Birth Weight Rate for Medicaid enrollees beginning in 2012.
The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately.
The observed rate for Low Birth Weight is presented by resident county (including a statewide total). The observed rate for low birth weight by resident zip code (including a statewide total) can be found here: https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/vk5f-rgqm/. For more information, check out: http://www.health.ny.gov/health_care/medicaid/ or go to the “About” tab.

The dataset contains the number of Medicaid Low Birth Weight newborns (numerator), the number of zip code Medicaid newborns (denominator), and observed rate for Agency for Healthcare Research and Quality Prevention Quality Indicator 9 (PQI 9) – Newborn Low Birth Weight Rate for Medicaid enrollees beginning in 2012.
The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately.
The observed rate for Low Birth Weight is presented by resident zip code (including a statewide
total). The observed rate for low birth weight by resident county: code (including a statewide total) can be found here: https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/aapx-etcg. For more information, check out: http://www.health.ny.gov/health_care/medicaid/ or go to the “About” tab.